Third- or Later-line Therapy for Metastatic Colorectal Cancer: Reviewing Best Practice

Tanios Bekaii-Saab, Richard Kim, Tae Won Kim, Juan Manuel O'Connor, John H. Strickler, David Malka, Andrea Sartore-Bianchi, Feng Bi, Kensei Yamaguchi, Takayuki Yoshino, Gerald W. Prager

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

An increasing number of patients with metastatic colorectal cancer (mCRC) are able to receive 3 or more lines of therapy. Treatments in this setting can include regorafenib (an oral multikinase inhibitor), trifluridine/tipiracil hydrochloride (TAS-102), antibodies that target epidermal growth factor receptor for patients with RAS wild-type tumors (if no prior exposure), and, where approved, anti-programmed cell death protein 1 inhibitors for patients with microsatellite instability-high mCRC. Although guidelines describe the available treatment options, few insights are provided to guide selection and sequencing. In this article, we share expert opinion from diverse geographic regions, to offer guidance for best practice when selecting and managing third-line treatment for mCRC. Various factors, including performance status, age, and tumor sidedness, can be used to guide treatment selection. Biomarkers, such as RAS, BRAF, and microsatellite instability, can be useful for treatment stratification. Management of adverse events, to maintain quality of life, is a key consideration and is crucial to best practice in this setting. Common toxicities associated with third-line treatments are hand-foot skin reaction, fatigue, diarrhea, and cytopenias. Patients who receive third-line and later-line treatments should be monitored for these events, especially during the first 2 cycles. Dose modifications can also be used to manage toxicities and to minimize the effect on quality of life, while maximizing treatment benefit. Clinical trials of emerging agents, new treatment combinations, and novel therapies continue the efforts to improve outcomes for patients with mCRC. Sharing expert opinions on best practice for treatment selection and management can ultimately improve outcomes for patients with mCRC.

Original languageEnglish (US)
JournalClinical Colorectal Cancer
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Practice Guidelines
Colorectal Neoplasms
Therapeutics
Microsatellite Instability
Expert Testimony
Programmed Cell Death 1 Receptor
Trifluridine
Quality of Life
Epidermal Growth Factor Receptor
Fatigue
Foot
Diarrhea
Neoplasms
Hand
Biomarkers
Clinical Trials
Guidelines
Skin

Keywords

  • Patient selection
  • Regorafenib
  • TAS-102
  • Treatment management
  • Trifluridine/tipiracil

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Third- or Later-line Therapy for Metastatic Colorectal Cancer : Reviewing Best Practice. / Bekaii-Saab, Tanios; Kim, Richard; Kim, Tae Won; O'Connor, Juan Manuel; Strickler, John H.; Malka, David; Sartore-Bianchi, Andrea; Bi, Feng; Yamaguchi, Kensei; Yoshino, Takayuki; Prager, Gerald W.

In: Clinical Colorectal Cancer, 01.01.2018.

Research output: Contribution to journalArticle

Bekaii-Saab, T, Kim, R, Kim, TW, O'Connor, JM, Strickler, JH, Malka, D, Sartore-Bianchi, A, Bi, F, Yamaguchi, K, Yoshino, T & Prager, GW 2018, 'Third- or Later-line Therapy for Metastatic Colorectal Cancer: Reviewing Best Practice', Clinical Colorectal Cancer. https://doi.org/10.1016/j.clcc.2018.11.002
Bekaii-Saab, Tanios ; Kim, Richard ; Kim, Tae Won ; O'Connor, Juan Manuel ; Strickler, John H. ; Malka, David ; Sartore-Bianchi, Andrea ; Bi, Feng ; Yamaguchi, Kensei ; Yoshino, Takayuki ; Prager, Gerald W. / Third- or Later-line Therapy for Metastatic Colorectal Cancer : Reviewing Best Practice. In: Clinical Colorectal Cancer. 2018.
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